The present invention relates to mouthpieces in general and in particular to a mouthpiece, about which a person may place his lips in an air-tight manner, and a tongue retractor for use in diagnosing and treating conditions of the throat, tonsilar, respiratory tract and related areas, and for use in evaluating a person's respiratory processes.
Currently there are available a number of devices having means for retracting or which, in use, incidentally retract a person's tongue when used for diagnosing and treating physical conditions of the throat area. Among the most commonly known of the devices there is the common tongue blade. The common tongue blade comprises an elongated stick-like member, which is usually disposable, comprising wood or plastic material. It is most commonly used during physical examinations and is placed on the upper surface of the tongue to depress the tongue for viewing the throat and tonsilar areas. Ordinarily, a person being examined with a tongue blade is conscious and not anesthetized. Anesthetic is not required because the blade is generally not placed so far into the mouth of a person that a significant gag reflex is elicited. Another device used for diagnosing conditions of the throat area, in particular the larynx, is the laryngoscope. The laryngoscope, in use, is passed over the tongue, incidentally depressing or retracting the tongue for viewing of the vocal cords and larynx area. When the laryngoscope is used, the person being examined must either be unconscious or anesthetized because the placement of the laryngoscope does elicit a significant gag reflex.
Other devices which involve retracting a person's tongue include a grooved tongue depressor of a type commonly known as a mouth gag. Instruments of this type are used in connection with oral surgery and in particular in connection with oral surgery where anesthesia is administered by way of endotracheal tubation. A device of this type is described in a patent issued to W. H. Ring, U.S. Pat. No. 3,154,069, Oct. 27, 1964. Another device involving a means for retracting a person's tongue is an endotracheal tongue blade with tube guide. Such instruments are commonly used for simultaneously propping open the jaws and depressing the tongue while affording a fairly unobstructed access to a patient's oral and pharyngeal cavities. The tube guide portion of the device provides a guide through which an endotracheal tube may be passed into the trachea for anesthesia purposes, for applying suction to the trachea and bronchi, and for maintaining an open breathing passage through the pharynx and trachea, etc. A device of this type is disclosed in a patent issued to R. T. Barton, U.S. Pat. No. 2,756,742, July 31, 1956. In use, the patient in which the device is used must either be unconscious or anesthetized in order to prevent the elicitation of a significant gag reflex as described above with respect to the previously described tongue depressor.
Another class of devices which employ tongue depressors for depressing a tongue are commonly called atomizers. Atomizers generally comprise a tube connected to an air bulb and a bottle containing a fluid, generally comprising medication. In use, the bulb is squeezed with sufficient force and speed so as to discharge a relatively high-velocity jet of air across an opening leading from the bottle. The relatively high-speed air creates a vacuum in the opening causing the fluid in the bottle to be sucked from the bottle and discharged with the air out the end of the tubular member. This is done while the tubular member is inserted in a person's mouth. The atomizers which employ a tongue depressor use the depressor for depressing the tongue so as to remove the tongue for more convenient and effective manipulation of the atomizer and direction of the spray. An atomizer of the type referred to is described in the patent to Hill et al., U.S. Pat. No. 862,737, dated Aug. 6, 1907 and the patent issued to Blackman, U.S. Pat. No. 487,873, dated Dec. 13, 1892. Because most atomizers, at least those used by the general public, are not inserted into the mouth to such an extent that they elicit significant gag reflexes, anesthesia is not generally required.
Another device which involves retracting a tongue during the use of the device is an emergency airway-providing device, which is generally used in unconscious persons for mouth-to-airway resuscitation. A device of this type is disclosed in U.S. Pat. No. 3,013,554, issued Dec. 12, 1961.
Referring in particular to the devices used for administering medication to the throat and pharyngeal areas, it may be noted that the means employed for administering medication and insuring that the medication reaches the rearmost and lowest portions of the throat is a relatively long, tubular member. As the tubular member is shortened, control over the distribution of the medication in the throat is reduced. With present-day inhalers using relatively short and relatively large mouthpieces, there is practically no control over the direction of the medication imparted to the throat, such that the medication can coat areas not intended to be coated. Depending on the type of nebulized medication employed, this may result in tingling sensations on a patient's tongue and even the development of a yeast infection.
While some of the above described devices employ a tongue retractor on incidentally retract a tongue when in use, none of the devices permits a person's lips to form about the device in an air-tight manner so as to prevent the passage of air between the lips and the device. All of the devices which use a tongue retractor placed far into a person's throat require that the person either be unconscious or that the throat and tongue area be anesthetized so as to prevent the elicitation of a significant gag reflex. None of the devices has a tongue retractor which is adjustable to accommodate different sized mouths. And, none of the devices is usable for evaluating a person's respiratory processes.
A mouthpiece used for evaluating a person's respiratory processes is disclosed in applicant's U.S. Pat. No. 3,742,939, issued July 3, 1973.
Referring to applicant's aforementioned patent, there is described in the specification, and shown in FIG. 7 thereof, a mouthpiece comprising a tubular member having a narrowed portion and a side port. The narrowed portion is provided to be inserted in a person's mouth.
In use, the mouthpiece is connected to a conventional spirometer and kymograph for measuring nasal or tracheobronchial airway resistance. When inserted in the mouth, the lips are closed about the narrowed portion of the tubular member of the mouthpiece in an air-tight manner.
During respirometry using the mouthpiece, inconsistent and unexplained deviations from expected results were observed. In a study of the observed results, it was found that the forced expiratory volume measured in a conventional manner was 2957 milliliters per second. When this determination was repeated with the tongue in front of the readily accessible mouthpiece, the one-second forced expiratory volume was 2558 milliliters per second. The difference was 399 milliliters per second, though the breaths were comparable.
In addition to permitting a person's tongue to obstruct the air flow therefrom, the prior known mouthpiece is also believed to adversely affect the air flow therefrom when it is used with a person having a trachea which is larger than the cross-sectional area of the mouthpiece. This is because the smaller mouthpiece will provide resistance to the air flow which can be interpreted as patient airway resistance.